Case study of cognitive behavioral therapy for depression (2023)

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  1. introduction

1.1 Depression

Depression is a deep, sad state in which life seems bleak and the challenges are overwhelming. Psychological stress is believed to play a crucial role in depression. People with depression often complain of constant tiredness and trouble sleeping. Other symptoms include irritability, anger, and loss of interest in activities that used to be pleasurable. A patient may also describe her emotions as feelings of emptiness or hopelessness. In addition, people with depression may have trouble concentrating, have memory problems, have difficulty making decisions, and may have trouble keeping normal work hours or meeting social obligations.

1.2 Cognitive-behavioral therapy

According to cognitive therapists, people with mental disorders can overcome their problems by developing new and more functional ways of thinking. Cognitive behavioral therapy helps the client make sense of overwhelming problems by breaking them down into smaller parts. This makes it easier to see how they are connected and how they are affecting him or her. These parts include situations that are more of a problem, event, or difficult situation. This is followed in the first part by thoughts, emotions, physical sensations, and actions. Therefore, therapists guide clients to question their dysfunctional thoughts and try new interpretations and ultimately apply the new ways of thinking in their daily lives.

1.3 Cognitive behavioral therapy for depression

For a patient with mild or moderate depression, CBT is known to be the most promising treatment. In patients with major depression, this is an effective treatment in conjunction with drug treatment. The main objective of CBT is to find out if a person's mood is directly related to their thought patterns.

This therapy has two main approaches to treating people with the disorder, consisting of cognitive and behavioral approaches. In the cognitive approach, the client's thought pattern is positively manipulated through working with the therapist. This is also known as cognitive restructuring.

Second, the behavioral approach involves the therapist helping the patient assess how their daily activities may affect the patient's mood. Therapists often help clients develop an action plan. In this approach, the therapist and patient create a list of activities, which are ranked from least to most difficult to perform. As the patient transitions from lighter to heavier activities, her sense of control improves as her depression lessens. The technique essentially focuses on the immediate present, helping the patient see what and how a person is thinking, rather than why a person is thinking that way.

  1. basic information

2.1 Reasons for transfer

Lakshani was once an active teenager who is now constantly idle at home or in bed. She shows no interest in any activity and seems to have no motivation or energy. She sleeps excessively and is always melancholy. Therefore, Lakshani's mother took her to a psychiatrist, who referred her to a psychologist, believing that psychotherapy would be more beneficial for the patient.

2.2 represent problems

Lakshani not only enjoyed playing badminton with her friends and neighbours, but also loved to read, sing and dance. In the last 3 months, her life has changed drastically. For example, before her behavior change, she liked to help her mother in the kitchen. However, now she spends all day curled up in bed. Her mother also noticed her loss of appetite. She says that she feels tired and sleepy all the time. She no longer feels motivated to get involved in any activities and she has no goals planned for the future.

(Video) Case study clinical example CBT: First session with a client with symptoms of depression (CBT model)

2.4 History of psychiatric and previous treatment

Lakshani previously had bouts of depression after her father abandoned her when she was 8 years old and was therefore prescribed antidepressants. She did not receive psychotherapy for this. As of now she is on a low dose of antidepressants.

2.4 Relevant Surnames

Lakshani is the only daughter in her family. When Lakshani was only 8 years old, her father divorced her mother to marry another woman. Although she was close to her father before this incident, she Lakshani did not get a chance to see him after she left. This was mainly because her parents ended things on particularly bad terms. However, her father took her life a year ago and, with the support of her mother, the couple reconciled. According to Lakshani, it was difficult for her to find herself again, especially since he has a new family.

The mother did not remarry and would have been quite saddened by the separation. Although her mother's suffering was obvious to Lakshani, she did not know what to make of it, as Lakshani herself was trying to handle the situation as best she could.

During this ordeal, she became very attached to her grandparents. She is particularly close to her grandfather.

2.6 Premorbid personality

Lakshani was a sociable girl who could easily make friends. She liked school and she showed great interest in certain activities and hobbies, such as playing badminton with her neighbors, reading, singing and dancing, as mentioned.

formulation 3.0

Lakshani's cause of her depression is gradually contained through many different incidents. The first event that affected her was the divorce of her parents. That incident hit her so hard that she couldn't go to school for a month afterward. The subsequent onset of similar events, particularly the violent breakup with her boyfriend, led her to believe that no one cares about her in her life and that they will all eventually leave ("no, I'm not smart, obviously I'm useless, no one cares for me." wants."). Thus, her pattern of attributing everything about herself negatively perpetuates her depressive symptoms. This formulation identifies the various incidents that may have contributed to Lakshani's negative thought pattern.

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(Video) Case Study: Sudden Gains from Depression | Cognitive Behavioral Therapy

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4. Intervention

4.1. Summary

Lakshani received weekly consultations and was required to attend 12 sessions over a period of 6 months. Her treatment consisted primarily of cognitive behavioral therapy approaches to identify and change negative dysfunctional thinking, as well as learning ways to prevent future relapses.

4.2 Commitment and psychoeducation

The initial treatment session worked to build a positive therapeutic alliance while maintaining professionalism. Lakshini revealed the recurring negative dysfunctional thoughts and how so far she has not made any courageous effort to change these considerations. Her symptoms were discussed and depression was diagnosed. A dialogue about depression was then introduced and Lakshini was educated about its influence on a person's behavior and how Lakshini experiences it personally. The structure, purpose and specific objectives of the next sessions were established, as well as the rules of therapy and the limits of confidentiality. The following three objectives were jointly identified

1) Short-term goal

Identify dysfunctional thoughts and how they affect Lakshani's mood and behavior.

2) Medium-term goal

Be more dynamic and participate in enjoyable activities.

(Video) Case study clinical example: First session with a client with symptoms of depression (CBT model)

3) Long-term goal

Develop interpersonal skills and a social support network.

Lakshani was informed that she will receive apersonal projectat the end of each session to complete them before the next session. This includes completing a 'mood thermometer' which allows for a better understanding of the intensity of depressive symptoms and the client's specific mood at the end of each day. Lakshani was also asked to keep a diary of all her positive and negative thoughts. Finally, she was asked to keep a weekly schedule of all the positive activities in which she was involved.

4.3. mood thermometer

Mood Thermometer allows Lakshani to measure your mood on a specific day of every week. The chart is examined before the start of the next session to measure Lakshani's progress. On the mood thermometer, Lakshani should score between 1 and 9, where 9 represents Lakshani's happiest feeling and 1 represents the worst.




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4.4 Relaxation exercises

Lakshani is asked to do specific relaxation exercises at home, especially when she feels stressed. This could include deep breathing exercises, asking her to sit in a comfortable position at home as she breathes out and slowly inhales to ensure that she is only concentrating on her breathing. This will allow you to put aside any other intrusive thoughts in her head and she will be able to feel more calm and uninterrupted. Other breathing exercises may include relaxation responses and progressive muscle relaxation. These breathing exercises can be followed by a visualization exercise in which Lakshani is asked to imagine or visualize herself in a specific scenario that she finds most calming or relaxing.

4.3 Acknowledge negative thoughts. (session 1-4)

While Lakshani's negative thinking errors and dysfunctional thoughts were identified and defined in the first session, the next three sessions will work on how to discuss and modify these thoughts to improve your state of mind. Exercises can be done in the session to identify her common thinking errors. These sessions will teach Lakshani strategies to increase positive thoughts and decrease harmful or dysfunctional negative thoughts, thereby reducing depressive symptoms. In other words, the cognitive restructuring of her negative thoughts is followed by behavioral experiments in which she learns to act on situations that acted as triggers for her dysfunctional thoughts.

cognitive restructuring


Example related to Lakshani situation


activation phase

Friends who don't answer the phone when she calls and don't answer when they miss her.



You don't want to talk to her.



Sadness, confusion, loneliness.



“No, they are also busy with their lives. Just because I was free at the time doesn't mean they were immediately available to take my call. And the reason they didn't call back was probably because they were too busy with what they were doing and therefore missed it. It is not personal."


New Effective Faith

When I call my friends, they are occasionally not available to answer the phone. But that doesn't mean they try to avoid me. I'll call you later when you're free.

behavioral experiments

After cognitive restructuring, in the behavioral experimentation phase, the Lakshani is asked to become familiar with their newly constructed thought patterns. To do this, he is first asked to do a role play in which he imagines a situation that is particularly difficult for him. He is gradually encouraged to engage in these new behaviors outside of the therapist's office. This would eventually reduce her unhealthy thinking and successfully reconstruct her behavior to better fit the situation (Pomerantz, 2013).

4.4 Engage in Enjoyable Activities/Activation of Behavior (Sessions 5-8)

Lakshani explains how the presence of depression can limit participation in pleasurable activities, which in turn increases depressive symptoms. During these sessions, the activities that Lakshani enjoys are determined and the obstacles that prevent her from engaging in these activities are also identified. Lakshani is given a list of enjoyable activities and is then asked to mark each activity that she does on that particular day. This keeps track of her progress and motivates them to engage in more and more positive activities. This, in turn, will reduce her depression.

To make things simpler and easier for her, you can set concrete and clear goals together and she can learn the steps to reach those specific goals.

(Video) CBT Role-Play - Depressive Symptoms and Lack of Motivation

weekly activity plan

This schedule contains all the activities that Lakshani will be involved in during the week. You are prompted to type a plus sign (+) if they are positive and a minus sign (-) if they are negative.

4.6 Development of interpersonal relationships (Session 9-12)

Lakshani learns how the way she interacts with those around her can affect her "mood" and vice versa. In this way, she learns what a good social support network needs and how to recognize and strengthen it. However, she also needs to understand that relationships are always changing and that certain relationships that don't work out don't necessarily mean she's at fault. As such, she is taught to maintain healthy relationships with her peers and family, considering that the deterioration of certain relationships is inevitable and such changes must be accepted.

There will also be specific exercises to help Lakshani build better relationships with her peers, where she will learn to set realistic expectations of them. In addition, she learns confident communication skills to help her interact with her friend without feeling pressured or insecure.

Lakshani is also asked to build her own social support network to gauge who she trusts the most in her social circle and whom she considers her close friends and family. When Lakshani's social circle is very small, she is asked to enlarge it as she needs a group of people that she can trust. A good social support network will greatly reduce her depressive symptoms.

4.7 Theme integration and therapy evaluation

The final session will integrate all the questions from the previous session while reviewing and evaluating the therapy and all the activities Lakshani was involved in. Lakshani receives information about her participation and her progress during the sessions. She is asked to give feedback on her personal opinions and experiences throughout therapy. She also learn strategies that can prevent a relapse.

Case study of cognitive behavioral therapy for depression (26)Case study of cognitive behavioral therapy for depression (27)HABITS TO AVOID

  • thinking all nothing
  • evaluate the positive
  • Case study of cognitive behavioral therapy for depression (28)conclude hastily
  • perfectionism
  • Label yourself or others
  • blame yourself

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What are examples of cognitive therapy for depression? ›

Examples of cognitive therapy in action

People with depression usually have lost interest in activities that used to give them pleasure. A cognitive therapist may schedule activities their patient used to enjoy, such as taking long walks or meditating, and encourage them to try engaging in them again.

How does cognitive behavioral therapy help treat depression? ›

Cognitive therapy is a treatment process that helps patients correct false self-beliefs that lead to certain moods and behaviors. The fundamental principle behind cognitive therapy is that a thought precedes a mood, and that both are interrelated with a person's environment, physical reaction, and subsequent behavior.

Does CBT work for depression study? ›

Enhanced versions of the most commonly used talking therapy for depression significantly reduces the illness beyond six months, a meta study of over 15,000 people has concluded.

What is cognitive behavioral therapy example scenario? ›

In cognitive behavioral therapy, people are often taught new skills that can be used in real-world situations. For example, someone with a substance use disorder might practice new coping skills and rehearse ways to avoid or deal with social situations that could potentially trigger a relapse.

What is the best cognitive therapy for depression? ›

CBT is the best-proven form of talk therapy, also called psychotherapy. It sometimes works as well as antidepressant drugs for some types of depression. Some research suggests that people who get CBT may be half as likely as those on medication alone to have depression again within a year.

Which type of cognitive therapy is most effective at treating depression? ›


Cognitive behavioral therapy (CBT) is one of the most evidence-based psychological interventions for the treatment of several psychiatric disorders such as depression, anxiety disorders, somatoform disorder, and substance use disorder.

What therapy is most successful in treating depression? ›

Cognitive Behavior Therapy (CBT)

This form of therapy is considered by many to be the gold standard in depression treatment.

What are the 5 steps of CBT? ›

5 Easy Steps to Changing Your Thinking Using Cognitive Behavioral Therapy (CBT)
  • Step One – Make A List.
  • Step Two – Record Unproductive Thoughts.
  • Step Three – Create Replacement Thoughts.
  • Step Four – Read Your List Often.
  • Step Five – Notice And Replace.
Oct 12, 2017

How long does CBT take to work for depression? ›

A highly effective psychotherapy called cognitive behavioral therapy (CBT) focuses on how our thoughts, beliefs, and attitudes can affect our feelings and behavior. Traditional CBT treatment usually requires weekly 30- to 60-minute sessions over 12 to 20 weeks.

How effective is CBT for depression percentage? ›

How Effective is CBT? Research shows that CBT is the most effective form of treatment for those coping with depression and anxiety. CBT alone is 50-75% effective for overcoming depression and anxiety after 5 – 15 modules.

What are the disadvantages of CBT for depression? ›

Some of the disadvantages of CBT to consider include:
  • you need to commit yourself to the process to get the most from it – a therapist can help and advise you, but they need your co-operation.
  • attending regular CBT sessions and carrying out any extra work between sessions can take up a lot of your time.

Why is CBT better than antidepressants? ›

This is because the skills people learn during a course of CBT can enable them to maintain the progress made after the treatment ends. Medications do however work faster than CBT. The difference is usually only a matter of weeks and for someone who is suffering from severe anxiety, a few weeks can feel like a lifetime.

What is a real life example of CBT? ›

What are examples of cognitive behavioral therapy? Examples of CBT techniques might include the following: Exposing yourself to situations that cause anxiety, like going into a crowded public space. Journaling about your thoughts throughout the day and recording your feelings about your thoughts.

What is an example of a technique commonly used in CBT? ›

One popular technique in CBT is ABC functional analysis. Functional analysis helps you (or the client) learn about yourself, specifically, what leads to specific behaviors and what consequences result from those behaviors.

Is CBT or DBT better for depression? ›

For depression, anxiety, OCD, phobias and PTSD, research has shown that CBT tends to be the more effective treatment. For borderline personality disorder, self-harm behaviors and chronic suicidal ideation, DBT tends to be the better choice.

How does CBT treat anxiety and depression? ›

CBT aims to stop negative cycles such as these by breaking down things that make you feel bad, anxious or scared. By making your problems more manageable, CBT can help you change your negative thought patterns and improve the way you feel.

What are the 3 basic approaches to treating depression? ›

Three of the more common methods used in depression treatment include cognitive behavioral therapy, interpersonal therapy, and psychodynamic therapy.

What are the 2 most effective treatment methods for most types of depression? ›

Medications and psychotherapy are effective for most people with depression. Your primary care doctor or psychiatrist can prescribe medications to relieve symptoms. However, many people with depression also benefit from seeing a psychiatrist, psychologist or other mental health professional.

What kind of therapy do people with depression need? ›

Because cognitive therapy and behavioral therapy work well together to treat depression and anxiety disorders, the two are often combined in an approach called cognitive behavioral therapy (CBT). CBT focuses on addressing both the negative thought patterns and the behaviors that contribute to depression.

What are the three C's of CBT? ›

Some clients may be familiar with the “3 C's” which is a formalized process for doing both the above techniques (Catch it, Check it, Change it). If so, practice and encourage them to apply the 3 C's to self- stigmatizing thoughts.

Can I do CBT on my own? ›

If you've wanted to try CBT for anxiety or depression but aren't able to see a CBT therapist, you may not need to. Many studies have found that self-directed CBT can be very effective.

Who would not benefit from CBT? ›

For patients with significant illness, such as a severe mood disorder for example, providers may need to initiate a trial of medications prior to starting CBT in order to facilitate session attendance and adherence. Individuals with very limited intellectual functioning may not fully benefit from CBT.

How long before CBT is effective? ›

How long does CBT take to treat moderate anxiety? 6 or 12 to 24 sessions of CBT therapy may be enough to successfully treat a presentation of moderate anxiety. Some people may need a bit longer, for instance where symptoms have been contained in the background for some years prior to treatment.

Why do some therapists not like CBT? ›

First, the sort of issues CBT draws attention to – bias, false beliefs, poor inferences – are all relatively common, even in mentally healthy people. As a great deal of psychological research has shown, we are all prone to poor reasoning.

Why is CBT criticized? ›

Criticisms of Traditional CBT

Given the dominance of CBT in certain settings, it is not surprising that the approach has garnered its fair share of critics. Opponents have frequently argued that the approach is too mechanistic and fails to address the concerns of the “whole” patient.

Can CBT make things worse? ›

Some people worry therapy might make things even worse. This can happen sometimes. this is because starting therapy can stir up emotions that you weren't aware of or had tried to ignore. This is normal, but can be tough.

What vitamin is a natural antidepressant? ›

Vitamin B-3 and Vitamin B-9 can help people with depression because B vitamins help the brain manage moods. Vitamin D, melatonin and St. John's Wort are recommended for seasonal depression. Omega-3 fatty acids, magnesium and vitamin C may also help with depression.

What is the success rate of therapy for depression? ›

To put this more clearly: If you are diagnosed with depression, you have a 24.2% chance of getting better (even after aggressive treatment, including multiple drugs and hospitalization). However, you're about twice as likely (41.4%) to be called “treatment-resistant” at the end of that treatment and see no improvement.

Does CBT increase serotonin? ›

Treatment for depression with cognitive behavioral therapy (CBT), which teaches ways to modify thoughts and behaviors that contribute to depression, may help in raising brain serotonin levels and in improving depressive symptoms.

How do you write a CBT case formulation? ›

4 Things to Include in Your Case Formulation
  1. Summary of the client's identifying information, referral questions, and timeline of important events or factors in their life. ...
  2. Statement of the client's core strengths. ...
  3. Statement concerning a client's limitations or weaknesses.
Feb 11, 2022

What is CBT most commonly used for? ›

Cognitive behavioral therapy (CBT) is a form of psychological treatment that has been demonstrated to be effective for a range of problems including depression, anxiety disorders, alcohol and drug use problems, marital problems, eating disorders, and severe mental illness.

What is an example of behavioral therapy? ›

For example, someone who is afraid of dogs can gradually expose themselves to dogs in a safe environment to eventually learn to overcome this particular fear. Exposure therapy is a way to treat phobias, such as a fear of heights.

What questions are asked in cognitive behavioral therapy? ›

20 CBT Therapy Question to ask Clients
  • What were you feeling right before you did that? (Affective)
  • What happens to you physically before this happens? ...
  • How do you normally act right before this happens? (Behavioral)
  • What thoughts go through your mind before this happens? (Cognitive)
Feb 7, 2020

What is cognitive therapy for the treatment of depression most likely to focus on helping people to do? ›

Using CBT to treat depression

CBT can help people with depression by giving you tools to challenge the negative thoughts and override them with more realistic and positive thought processes.

How do you reframe negative thoughts? ›

Here's how to get started with reframing unhelpful thoughts.
  1. Notice the thought. Pay attention to thoughts that are discouraging. ...
  2. Question the thought. Look at that thought, without judging it, and ask yourself whether it is helpful or true. ...
  3. Replace the unhelpful thought with a more helpful one.

What do therapists do in cognitive behavioral therapy? ›

You work with a mental health counselor (psychotherapist or therapist) in a structured way, attending a limited number of sessions. CBT helps you become aware of inaccurate or negative thinking so you can view challenging situations more clearly and respond to them in a more effective way.

What are CBT worksheets? ›

The CBT Model Info Sheet is a one-page worksheet designed to explain the cognitive model through accessible writing and examples. Your clients will learn how their thoughts, emotions, and behaviors interact, and the value of changing their negative thinking patterns.

What are some cognitive therapy techniques? ›

Some of the techniques that are most often used with CBT include the following 9 strategies:
  • Cognitive restructuring or reframing. ...
  • Guided discovery. ...
  • Exposure therapy. ...
  • Journaling and thought records. ...
  • Activity scheduling and behavior activation. ...
  • Behavioral experiments. ...
  • Relaxation and stress reduction techniques. ...
  • Role playing.
Dec 12, 2019

What are the 3 types of cognitive therapies? ›

Types of Cognitive Behavioral Therapy

Cognitive Therapy (CT) Dialectical Behavior Therapy (DBT) Rational Emotive Behavior Therapy (REBT)

What are 3 major aspects of cognitive behavioral therapy? ›

Gaining a better understanding of the behavior and motivation of others. Using problem-solving skills to cope with difficult situations. Learning to develop a greater sense of confidence in one's own abilities.

What is a real life example of cognitive psychology? ›

The concept of learning itself is also an example of cognition. This is about the way in which the brain makes connections while remembering what is learned. The ability to reason logically is an excellent example of cognition, problem solving and making judgments about information.

What are the 5 components of cognitive behavioral therapy? ›

In CBT, problems are broken down into 5 main areas:
  • situations.
  • thoughts.
  • emotions.
  • physical feelings.
  • actions.

What are the 4 steps of CBT? ›

CBT typically includes these steps:
  • Identify troubling situations or conditions in your life. ...
  • Become aware of your thoughts, emotions and beliefs about these problems. ...
  • Identify negative or inaccurate thinking. ...
  • Reshape negative or inaccurate thinking.
Mar 16, 2019

When is CBT not appropriate? ›

it may not be suitable for people with more complex mental health needs or learning difficulties. it involves confronting your emotions and anxieties – you may experience initial periods where you're anxious or emotionally uncomfortable.

Is CBT or medication better for depression? ›

Recent research findings suggest that cognitive behavioral therapy and similar modalities are more effective than SSRIs in the treatment of depression. Patients who are treated with therapy experience shorter depressive episodes and are less likely to relapse.


1. CBT for Depression: The Basics
2. 2 Vital CBT Techniques For Depression
(Uncommon Practitioners)
3. How Does Cognitive Behavioral Therapy Work?
(Psych Hub)
4. Cognitive Behavioral Therapy for Depression Video
5. Introduction to Cognitive Behavioral Therapy for Depression
(Friends & Supporters)
6. What is Cognitive Behavioral Therapy?
(Psych Hub)
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